First part of the Physical Examination that begins the moment the nurse meets the client
General Survey
Requires the nurse to use all of her observational skills (inspection) while interviewing and interacting with the client
These observations will lead to clues about the health status of the client
The outcome of the general survey provides the nurse with an overall impression of the client's whole being
Physical Assessment
Systematic, comprehensive, continuous collection, validation, and communication of client's data using a variety of methods
Assessing Appearance and Mental Status
1. Explain procedure to the patient
2. Do handwashing
3. Provide privacy
4. Observe body built, height, and weight
Marfan Syndrome
Disorder of connective tissues manifested by changes in the skeleton, eyes, and cardiovascular system
Inherited gene defects in fibrillin (a glycoprotein) result in formation of abnormal elastic fibers
Gigantism
Enlarged soft tissue and late closure of the growth plates
Dwarfism
Essentially a person with short stature
Little People of America (LPA) – 4'10" or under
May be caused by: Gonadal dysgenesis (XO → Turner syndrome), Bone and metabolic diseases, No known cause (constitutional delayed growth), Chronic abuse and neglect (independent of nutrition), Genetic mutations (achondroplasia)
Proportionate Dwarfism
The same size all over (e.g. hypothyroidism)
Disproportionate Dwarfism
May have some average-size parts of the body
Achondroplasia
Most common form of dwarfism
Happens when growth plate chondrocytes are inhibited from functioning and proliferating (leads to suppression of epiphyseal plates)
Epiphyseal plates will close 12-14 years old for females and 16-18 for males
This stunts growth (but may have average-size portions of their bodies → torso)
Sthenic
Normal average body type
Average height, well-developed musculature, wide shoulders, flat abdomen, and oval face
Muscular, thick-set individual, with broad chest and high diaphragm
Stomach tends to lie transversely
Gallbladder is high in the abdomen (away from midline)
Transverse colon also high
Hypersthenic
Short, stocky, may be obese, broader chest, thicker abdominal wall, rectangular-shaped face
Very muscular, thick-set individual (higher weight class)
Broad chest
High diaphragm
Stomach tends to lie transversely
Gallbladder is horizontal high in the abdomen (away from midline)
Lower positioned organs (diaphragm, stomach, gallbladder, and transverse colon)
Stomach and transverse colon descend into pelvis (during erect position)
Exaggeration of the hyposthenic type
Hyposthenic
Tall, willowy, poorly developed musculature, long, flat chest, abdomen may sag, long neck, triangular face
Similar to asthenic but features mentioned are not as marked
Cachectic (Cachexia)
Profound and marked malnutrition
Wasting (muscle wasting – primary source of energy is glucose → if patient doesn't eat → muscle loss)
Ill health (chronic conditions such as cancer, CRF, HIV, MS)
Debilitated
Weak, feeble, lack of strength (with weakness and loss of energy)
Failure to Thrive
Physical and developmental delay or retardation in infants and children
Due to malnutrition
Seen in children with illness but more in those with psychosocial or maternal deprivation
Endomorph
Stocky build, with prominent abdomen
Ectomorph
Physiological type that is tall with long and lean limbs
Mesomorph
Husky and muscular body
Body Mass Index (BMI)
Ratio of your weight and height
Weight in kilograms divided by height in meters squared
Weight in pounds multiplied to 700, divided by height in inches, divided again by height in inches
Waist Circumference
Male: ≤ 102 cm (40 in)
Female: ≤ 88 cm (35 in)
Abnormal: anything beyond the measurements
Obesity
Can be caused by: Poor diet (high in fat and calories), Sedentary lifestyle, Not enough sleep, Genetics, Increasing age, Pregnancy
Gynoid/Gynecoid Obesity
Fats are located on the hips and thighs
Peripheral type of obesity
Android Obesity
Fats are located mainly on the waist
Central type of obesity
Increases risk for certain diseases (diabetes mellitus II, high cholesterol and triglycerides, hypertension, and heart disease)
Thrombus or emboli → inside small blood vessels → occlusion or blockage of blood vessel → reduces blood flow and oxygen to the brain → Ischemic CVA (no oxygen supply = irreversible brain damage/brain death can happen after 2 minutes)
Cushing Syndrome
Due to excess cortisol in the body (from medications or pituitary gland tumor)
Truncal fat (abdominal fat)
Thin limbs (relatively)
Cardiac hypertrophy (abnormal enlargement of heart muscle)
Abdominal striae (stretch marks)
Amenorrhea (doesn't have menstrual period)
Unplanned weight loss
Can be caused by: Cancer, Diabetes mellitus, Hyperthyroidism, Depression, Diuresis
Posture and Gait Assessment
1. Let patient stand against the wall (with shoulders lying flat)
2. Let patient sit on a chair with backrest
3. Let him/her walk towards you
4. Be aware: walking has 8 phases (motion of walking)
Normal Posture and Gait
Evenly distributed weight
Able to stand on heels and toes
Toes pointed straight ahead (equal on both sides)
Posture erect, movements coordinated and rhythmic, arms swing in opposition, stride length is appropriate
Abnormal Posture and Gait
Limping/discomfort (Antalgic/Limping gait)
Shuffling (common in Parkinson's disease; in elderly)
Wide/broad base gait (can have structural deformities/ fracture in the hip)
Fear of falling (Psychogenic)
Loss of balance (Drunkenness)
Movement disorder (Ataxic Gait)
Scoliosis
"S" formation
Lateral curvature in the normally straight vertical line of the spine
Lordosis
Excessive inward curve of the spine
Exaggerated lumbar concavity
Kyphosis (Hunchback)
Increased forward curvature of the spine
Causes hunching of the back
COPD Posture
Lean forward
Brace selves with arms
Tripod position
Depression Posture
Slumped position
When patient is withdrawn or isolated
Tense/Anxious Posture
Shoulders elevated
Stiff (especially in the neck)
Nail biting
Facial expression
Breath Odors
Alcohol breath
Halitosis (bad breath caused by food particles, and bacteria, etc.)